Elsevier

Public Health

Volume 124, Issue 11, November 2010, Pages 629-631
Public Health

Minisymposium
Public health gains from health in prisons in Spain

https://doi.org/10.1016/j.puhe.2010.08.007Get rights and content

Summary

An epidemic of HIV infections which occurred in Spanish prisons at the turn of the century led to the establishment of a comprehensive set of harm reduction measures including needle and syringe exchange in prisons throughout the country. This article outlines the measures taken and the impact they had in greatly reducing the infection rates of HIV and the cases of AIDS.

Section snippets

The context: the social and health environment

The impressive results achieved by prison health in Spain in its fight against the most common communicable diseases in prisons can be best understood if the history of health services in prison is known. Until the 19th century there was not a real medical care system in prisons. Until then, the ‘custody prison’ prevailed, holding those to go before the relevant Court and there was a range of punishments such as whipping, mutilation and even the death sentence.

Health within the prison setting

The HIV/AIDS epidemic

Although detached from community health services, the prison health services developed progressively through the 1980s. Part of the evolution was a consequence of one of the modern pandemics capable of achieving a high prevalence in prison settings, namely HIV/AIDS. This infection, closely related to drug abuse by injection, was widely spread amongst prisoners due to the high rates of injecting drug use in prisons. Within WHO, a Consultation Statement on the Prevention and the Fight against

Prison populations

Generally, the population within European prisons is made up of people from the most vulnerable social sectors with a high risk of social exclusion and poverty. People under confinement usually have worse physical and mental health than the general population. Their lifestyles have usually implied the risk of suffering certain diseases, many of them communicable. Many of them have never or rarely had contact with health services prior to their imprisonment. Mental disorders, drug abuse and

Results and remaining challenges

From the registry, we have noticed the following:

  • 1.

    There has been an obvious reduction trend in the infection by HIV during the last few years, so that the current prevalence is almost 3.5 times lower than that recorded in 1994 (Fig. 1);

  • 2.

    the incidence of AIDS has been reduced by 16% since 1995, the year the current fall started;

  • 3.

    the parenteral route is the main route in diagnosed cases in prison although that has fallen by 16% since 1991; this has been achieved at the expense of an increase in

Ethical approval

None required.

Funding

None declared.

Competing interests

None declared.

References (2)

  • M.P.A. Peña et al.

    Calidad asistencial en sanidad penitenciana en España

    (May 2010)
  • Bolentín Epidemiológico de Instituciones Penitenciarias

    (November–December 2009)

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